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Acyclovir - Acyclovir tablet
Triple-S
Triple-S Coverage for Acyclovir - Acyclovir tablet
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5
Commercial
2
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1
Medicare
2
Commercial
Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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Commercial - Other Insurer
No PA
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
No PA
No Step Therapy
No Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
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Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
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